Medical Evidence Confirms Diabetes

The lack of specific clinical symptoms of arsenicosis such as Mees' lines, hyperkeratosis and raindrop pigmentation indicates that arsenic poisoning was not to blame for the illness of Srila Prabhupada. Rather, his condition was symptomatic of type 2 diabetes mellitus, causing high blood pressure, peripheral neuropathy and heart problems, including myocardial infarction and stroke. In later stages this progressed to diabetic nephropathy (severe kidney damage due to diabetes), which led to uremia (buildup of metabolic toxins which are normally excreted by the kidneys) causing gastrointestinal disturbances and loss of appetite. In the final stages the loss of appetite and poor digestion led to malnutrition, and ultimately total systemic collapse. This diagnosis has been confirmed by doctors Jacob and McIrvine (who treated Prabhupada in his final months) as well as Prabhupada's personal nurse Abhirama Das.

In this chapter we will concentrate on the clinical symptoms manifest in Srila Prabhupada's body throughout his well-documented physical illness, indicating:

1. The lack of symptoms of arsenic poisoning, and 2. The marked presence of specific symptoms associated with chronic diabetes.

Clinical Symptoms of Arsenicosis

The clinical features of arsenic poisoning include multi-organ failure and other non-specific systemic indications, which sometimes lead to incorrect or delayed diagnosis. However, there are specific symptoms peculiar to arsenicosis. Bansal et al.1 report that prolonged sub-acute poisoning usually causes neuropathy (peripheral nervous system damage), with characteristic skin changes such as hyperkeratosis (thickening of skin) of palms and soles, hyperpigmentation or raindrop shaped depigmentation over the skin of the trunk and Mees' lines over the nails. Shin2 documents gastrointestinal upset, multi-organ failure, dermatological lesions and Mees' lines as common findings and Dipankar Das3 et al. report arsenical skin lesions as the most commonly observed symptom in a study of over 175,000 people drinking arsenic contaminated water in West Bengal, India.

Therefore, while arsenic poisoning causes multi-system damage that imitates many other diseases, the dermatological features (keratosis of palms and soles, raindrop pigmentation), polyneuropathy, and Mees' lines are more specific to arsenicosis and shall be dealt with in more detail, with specific reference to the clinical features displayed by Srila Prabhupada.

Dermatological Features

Hyperpigmentation is reported to be the most common change seen in people exposed to arsenic. This increased skin colouring can occur anywhere, but is accentuated in areas which are more heavily pigmented such as the groin or areola. There may be areas of lighter pigment among the darker areas, giving the overall appearance of "raindrops on a dusty road."

Hyperkeratosis, a thickening of the skin on the palms and soles, is also a very common indicator of arsenic poisoning.1,3 This is a very obvious clinical symptom which can be observed by anyone having close contact with the patient.

From reports by Srila Prabhupada's disciples who served him intimately during his final weeks, it is clear that none of them noticed any of these kinds of dermatological changes. These disciples were intimately serving, massaging and constantly monitoring Prabhupada's health. They were noting carefully his fluid intake, diet, regularity of bodily functions, medications and their effects. We could assume that if such dermatological changes had taken place, then certainly these disciples would have noticed them.

Prabhupada's personal nurse, Abhirama Das gives a typical response to the question of hyperkeratosis:

"I massaged his feet and hands for a minimum of one hour every day. Some days it was two or three hours. His skin was unusually soft, and his hands and feet were the most flexible and soft that I have ever experienced."

Personal servant Hari Sauri Das confirms this fact:

"Srila Prabhupada's skin was soft and smooth right to the very end. I always marvelled at how soft the soles of his feet and the palms of his hands were when I used to massage him (I mentioned this in the first volume of my Diary also), and I didn't notice any difference at all during the last six weeks in Vrindavana.

In his book, Nityananda Das presents the alleged poisoning of Napolean as accepted fact among the scientific and medical community. Interestingly, most of the available literature on the topic actually debunks the idea that Napolean was poisoned.

In their paper on the non-poisonous death of Napolean, Doctors Hindmarsh and Corso use the same reasoning to counter the allegation of poisoning as that given above:

"The most prominent dermatologic feature of chronic arsenic poisoning is also constant: raindrop pigmentation of the skin, particularly around the axillae, groins, temples, eye, neck and nipples, although it may also extend over the shoulders and chest anteriorly and posteriorly. Hyperkeratosis of the palms of the hands and soles of the feet is also often present, frequently associated with arsenic "corns". These features were clearly not present at death, as Henry reports that the skin was "white and delicate as were the hands and arms."

Dermatolgical effects are the most common indicators of arsenicosis. Therefore the lack of observable dermatological signs and symptoms alone throws great doubt on the arsenic poisoning theory.

Peripheral Neuropathy

The most common effect of arsenic intoxication on the nervous system is the appearance of a symmetrical polyneuropathy (nerve damage) which may appear within days of a large dose, or gradually with smaller regular doses of arsenic. This results in loss of touch and pain sensation in the extremities.

When making a diagnosis of neuropathic symptoms it is important to determine whether the disease is a polyneuropathy or mononeuropathy multiplex. Polyneuropathy refers to bilaterally symmetrical affection of peripheral nerves (i.e. both arms or both legs), whereas moneuropathy multipex randomly affects different nerves.

There is a large body of literature confirming clinical polyneuropathy as a symptom of arsenicosis, as exemplified by the study of J Oh Shin:

"In all cases, arsenic neuropathy was clinically characterised by a subacutely developing symmetrical sensory-motor polyneuropathy."

Nityananda Das has asserted that the neuropathy exhibited by Srila Prabhupada was due to arsenic intoxication, citing the example of Prabhupada suffering from paralysis and extreme pain in one leg. However, this is clearly a mononeuropathy, rather than a bilaterally symmetrical polyneuropathy.

One of the primary causes of sub-acute mononeuropathy is diabetes, whereas sub-acute symmetrical polyneuropathy may be caused by nutiritional deficiencies, drug intoxication or heavy metal poisoning, including arsenic.

Although the extreme pain and paralysis in Prabhupada's left leg is consistent with a mononeuropathy resulting from diabetes, it is clearly not a symmetrical polyneuropathy and therefore certainly rules out arsenic poisoning as the cause of this symptom.

The marked absence of a symmetrical polyneuropathy further undermines the idea that Prabhupada was suffering symptoms of arsenic poisoning.

Mees' Lines

A peculiar phenomenon associated with arsenic intoxication is Mees' lines, which are transverse bands of white and dark lines (usually from 1 to 3) on the nails of the fingers and toes. This is caused by bandlike precipitations of arsenic within the keratin matrix of the fingernails, and is first noticed approximately eleven days after onset of disease and remains as a succession of bands for over three months. Quecedo et al.reported three out of four cases of arsenic poisoning demonstrating prominent Mees' lines, with these being an important clue for diagnosis. Shin described Mees' lines as "the most helpful diagnostic finding of arsenic polyneuropathy" , with over 80% of cases exhibiting this symptom.

Abhirama Das gives first hand testimony about the clarity of Prabhupada's nails:

"I always pinced his nails, during massage as a part of stimulating his nerves. His nails where shiny, pink, smooth, with no discoloration or white lines."

Again, those who personally massaged Prabhupada's hands and legs daily failed to notice any unusual lines on the nails of his hands or feet. Thus another classic sign of arsenicosis is found to be missing from the symptoms shown by Srila Prabhupada.

Summary of arsenic symptoms

The only symptoms of arsenicosis which Srila Prabhupada displayed (gastro-intestinal upset and multi-organ failure) are those which are non-specific and common to many other systemic diseases, most notably diabetes. The distinct lack of any of the symptoms specifically associated with arsenic poisoning (hyperkeratosis, raindrop pigmentation, sub-acute
polyneuropathy, Mees' lines) throws grave doubt on the hypothesis that Prabhupada was actually suffering from arsenicosis.

One may make a case for such poisoning based on personal interpretation and speculatory innuendo, but based on available medical literature and the clinical history of Srila Prabhupada's illness, such a claim has no support whatsoever.

Clinical Symptoms of Diabetes

Type 2 diabetes mellitus is one of the most prevalent and disruptive diseases affecting the older population, with approximately 10% of all people over 65 years of age suffering from the disease. The cause is improper insulin utilization by the body, and the clinical features are well documented.
Diabetes damages small blood vessels throughout the body, affecting the kidneys as well as other organs and tissues including skin, nerves, muscles, intestines and the heart. Patients with diabetes can develop high blood pressure as well as rapid hardening of the arteries, which can lead to heart disease and eye disorders.

The fact that Srila Prabhupada suffered from diabetes was common knowledge among ISKCON devotees from at least 1969. Several doctors had diagnosed it and he himself was aware of it:

Gargamuni: My father, he also used to get swelling, but this was due to diabetes.
Prabhupada: I have got diabetes also.
Room conversation January 19, 1977. Bhubaneswara.

He also gave his personal servant Sruta Kirti Das and nurse Abhirama Das the same information.

Dr. McIrvine, who treated Srila Prabhupada in 1977, made the following diagnosis of his condition:

1. Due to diabetes, he suffered swelling which affected the flow in his urinary tract over many years
2. He had since birth a slightly restricted urethra which further reduced the urinary flow.
3. The combination of these two factors had put constant and harmful back pressure on his kidneys, which along with a general deterioration due to age had inflicted serious renal damage.

Dr. Karl Jacob also confirms the diagnoses:

"Srila Prabhupada's chronic diabetes, which was never medically properly treated, was bound to lead to other serious consequent diseases which had to increasingly manifest in his body: such as premature aging and degradation of blood vessels, microangiopathy, high blood pressure, heart problems, and diabetic nephropathy (severe kidney damage)...In addition his urethra was constricted which put a constant back pressure on the kidneys, increasing the renal insufficiency and inducing further damage."

Prabhupada exhibited many of the classic symptoms of type 2 diabetes mellitus (increased thirst, increased need to urinate, cardiovascular disease with heart attack and stroke, kidney disease). These will be documented to further substantiate the prognosis of diabetes mellitus.

Polydipsia (increased thirst)

Most people with type 2 diabetes experience an increased thirst along with increased need to urinate, this is one of the most common signs of diabetes type 2.

Although the fact that Prabhupada kept water by his side constantly is well known, the medical implication of this has previously gone unnoticed. Srila Prabhupada's personal servants Hari Sauri Das and Srutakirti Das confirm that Prabhupada drank a lot of water. He always kept a jug on his desk, and he frequently drank from it.

This is certainly consistent with the clinical features of type 2 diabetes mellitus, and further points to this being the underlying cause for Prabhupada's degenerating health.

Polyuria (increased need to urinate)

This is the other most common effect of type 2 diabetes, and was documented by Hari Sauri Das in his diary of May 4, 1976

He is again having trouble with uremia, using the bathroom every hour.

Cardiovascular disease

A common complication of diabetes mellitus is cardiovascular disease, often leading to myocardial infarction (heart attack) or stroke. This is caused by diabetic arteriosclerosis (hardening of the arteries). Prabhupada's history of cardiovascular disease is well known. In September of 1965, he suffered two severe heart attacks while on board the Jaladuta cargo ship on his way to America. Again in May of 1967 he suffered from serious heart palpitations and a stroke which paralysed the left side of his body.

This is referred to in many recorded conversations, including the following one from 1976:

Prabhupada: Because the time was taken, extension. Then, in 1967, in July, I thought, "Now the health is broken." I was very sick after heartstroke. So I thought "Now I shall not exist. So let me go to Vrndavana and die there." So I came back in July 1967. So this Brahmananda and others, they were crying when I got on the boat. Hm? The heart was so weak..

Prabhupada's personal servant, Hari Sauri Das also reports similar problems in 1976:

He is experiencing disturbing heart palpitations and his uremia has caused his legs and feet to swell again. It was a strain for him to even be out.

Thus the symptoms of cardiovascular disease with myocardial infarction and stroke were prominent in Srila Prabhupada's condition from when he first left India in 1965, adding further weight to the prognosis of chronic diabetes, causing heart disease and later kidney failure.

Nephropathy (kidney damage)

Diabetes is the single leading cause of all chronic kidney failure in the U.S. and at least one third of people with diabetes develop kidney disease.

Kidney disease was repeatedly diagnosed by doctors who attended to Srila Prabhupada:

Tamal Krishna: No, but all along, all of the doctors say it is kidney trouble. All of the doctors, allopathic and kaviraja agree kidneys are defective. And the surgeon in London, he also said so.
Room conversation, October 20, 1977. Vrindavan.

The National Kidney Foundation (U.S.) lists swelling of the legs and increased need to urinate as sure signs that a diabetic is developing kidney disease. These symptoms were repeatedly reported as early as 1975 by Hari Sauri Das in his personal diary, and Prabhupada himself attributed it to kidney damage causing uremia.

Prabhupada is not feeling well; swelling in his legs, feet and hands trouble him. To see his body puffed with fluid is very disturbing...Prabhupada said this is due to uremia, a toxic condition caused by waste products in the blood normally eliminated in the urine. It makes it very difficult for him to climb the steps to his apartment when returning from the temple.
December 20, 1975.

He is again having trouble with uremia, using the bathroom every hour. His feet are badly swollen and he is suffering dizzy spells.
May 4, 1976.

He was ashen, and told me he was experiencing severe kidney pain and could not translate. It was the same problem he had a few days ago.
July 15, 1976.

Doctors Jacob and McIrvine confirm that severe kidney damage had taken place, brought about by prolonged untreated diabetes. All available clinical evidence and information from the medical literature fully supports their findings.

Retinopathy

Diabetic retinopathy is the most frequent cause of new blindness in adults aged 20-74. Damage is caused by constriction of small blood vessels in the retina, which impairs vision. In his last 2 months, Prabhupada suffered from partial blindness. This is consistent with diabetic retinopathy.

Peripheral Neuropathy

Diabetes mellitus is often characterised by a tingling sensation and loss of feeling in the legs. Due to Prabhupada's policy of not discussing his health situation unless it made it impossible for him to work, it is not known if he experienced these more subtle clinical signs of diabetes.

Srila Prabhupada exhibited motor-sensory loss in his left leg during the final month of his illness, as documented in the diary of his personal secretary, Tamal Krishna Goswami.

Prabhupada's left leg was beginning to feel very heavy. When he asked my opinion whether it was paralyzed, I suggested that the blood was not circulating because of inactivity.
October 23, 1977

"I am not getting strength. Even to lift my leg, I need help. Practically my left leg is not working. What should be done now, you consider."
November 11, 1977

The problem in Prabhupada's left leg, where he experienced severe pain and paralysis during his last month, could have been due to a diabetic sub-acute moneuropathy, as described by Herting and Frohberg. As discussed earlier, it was obviously not a bilaterally symmetrical polyneuropathy, characteristic of heavy metal poisoning.

Dry, Itchy Skin

The American Diabetes Association describes dry, itchy skin as one of the six most common signs of type 2 diabetes.

Prabhupada's routine of having a full body massage with mustard oil daily prevented his skin from drying out, however, itchiness was experienced by him during the last six months of his illness, as described in Tamal Krishna Goswami's diary.

When Prabhupada woke up at six thirty, he had me scratch his back. Then he went to sit in the garden.
June 7

When he wakes up, usually around 6:00 a.m., he opens his eyes and looks at me. Then after some time, he holds out his arms and I pull him up. I sit behind him and scratch his back, which has lines in the skin from lying down. At this time, he usually talks casually.
July 4

Prabhupada interrupted and asked for someone to scratch his back. Kirtanananda Swami responded. Prabhupada asked, "Anyone can scratch very hard?" Kirtanananda Swami objected, "I'm afraid you'll have no back left!"
October 9

That Prabhuapda experienced itchiness of his skin is a further positive sign that he was suffering from advanced diabetes type 2.

Table 1. Symptoms of arsenicosis and their presence or absence in Srila Prabhupada's condition.

Clinical symptoms of arsenicosis Clinical feature of
Prabhupada's condition

Raindrop pigmentation No
Mees' lines No
Dermatological lesions No
Hyperkeratosis No
Symmetrical sub-acute polyneuropathy No
Gastrointestinal upset Yes
Multiple organ failure Yes

Table 2. Symptoms of diabetes and their presence or absence in Srila Prabhupada's condition.

Clinical symptoms Clinical feature of
of diabetes mellitus Prabhupada's condition

Polydypsia (excessive thirst) Yes
Polyuria (increased need to urinate) Yes
Heart attack Yes
Stroke Yes
Nephropathy (kidney damage) Yes
High blood pressure Yes
Retinopathy Yes
Sub-acute moneuropathy Yes
Repeated or hard to heal infections
of the skin or bladder Yes
Dry, itchy skin Yes

Table 3. Symptoms of diabetes advancing to kidney disease and their presence or absence in Prabhupada's condition.

Clinical symptoms Clinical feature
of diabetes advancing of Prabhupada's
to kidney disease condition

Swelling of legs and hands Yes
Morning sickness, nausea and vomiting Yes
High blood pressure Yes
Polyuria (increased need to urinate) Yes
Protein in the urine Yes
Weakness, paleness and anemia Yes

Conclusion

There is no strong evidence either clinical or medical, that Srila Prabhupada suffered from chronic arsenic poisoning. The
only symptoms of arsenicosis he experienced were those of a highly non-specific nature, namely gastrointestinal upset and
multiple organ failure. None of the clinically specific signs attributable to arsenic intoxication were observed in Srila
Prabhupada.

Interestingly, there are many parallels between the claims made by Nityananda Das and those made by S. Forshufvud
regarding the death of Napolean. In their 1996 rebuttal to the Napolean poisoning theory, Doctors Corso and Hindmarsh
make the following observations in summing up their case:
Napolean...failed to show some of the classic signs of arsenic poisoning, including thickening and pigmentation of the palms
of the hands, irregularities of the nail beds and a sensory neuropathy of the lower legs. Specific note was made at autopsy of
the clear and almost ivory-like quality of his skin, certainly something not seen in someone suffering from chronic arsenic
poisoning...Also, Ernest Chioda, a noted medical toxicologist and lawyer, stated at the debate that both from a medical and a
legal standpoint, no case whatsoever can be made for the poisoning of Napolean as a criminal act.

On the other hand, there is significant and compelling evidence attested to by eight doctors all present at Napoleon's autopsy
that indeed he died of a cancer of the stomach complicated or associated with a perforating chronic ulcer.6

In the case of Srila Prabhupada, we also find that there is significant and compelling evidence, based on the clinical record
and testimony of doctors who personally treated him, that he was suffering primarily the symptoms of advanced diabetes,
which, having gone untreated for decades, led to further complications, most notably coronary heart disease and kidney
failure. In contrast, the theory that he was poisoned with arsenic is utterly baseless and is not substantiated by the medical
evidence in any way whatsoever.

References

1. Bansal SK, Haldar N, Dhand UK, Chopra JS. Phrenic Neuropathy in Arsenic Poisoning. Chest 1991;100(3):878-
880
2. Shin J Oh. Electrophysiological Profile in Arsenic Neuropathy. J Neurol Neurosurg Psychiatry 1991;54:1103-
1105
3. Das D, Chatterjee A, Mandal BK, Samanta G, Chakraborti D. Arsenic in Ground Water in Six districts of West
Bengal, India. Analyst 1995;120:917-924
4. Shannon RL, Strayer DS. Arsenic-induced Skin Toxicity. Hum Toxicol 1989;8:99-104
5. Yeh S. Skin Cancer in Chronic Arsenicism. Hum Pathol 1973;4:469-485
6. Corso PF, Hindmarsh T. Further Scientific Evidence of the Non-Poisonous Death of Napolean Bonaparte Sc
Prog 1996;79(2):89-96
7. Hindmarsh T, Corso PF. The Death of Napolean Bonaparte:A Critical Review of the Cause. J Hist Med
1998;53:201-218
8. Murphy MJ, Lyon LW, Taylor JW. Subacute Arsenic Neuropathy: Clinical and Electrophysical Observations. J
Neurol Neurosurg Psychiatry 1981;44:896-900
9. Herting RL, Frohberg NR. Neurology: Peripheral Neuropathy. University of Iowa Family Practice Handbook,
3rd Edition, Chapter 14.
10. Conomy JP. A Succession of Mees' Lines in Arsenical Polyneuropathy,
11. Butler RN, Rubenstein AH, Gracia AG, Zweig SC. Type 2 Diabetes: Causes, Complications and Screening Recommendations. Geriatrics 1998;53(3):47-54
12. Bhaktivedanta Book Trust. Complete Works of Srila Prabhupada. 1991
13. Hari Sauri Das, Jahnu Das. A Reply to the Poison CD.
14. Satsvarup Das Goswami. Srila Prabhupada Lilamrita.
15. Hari Sauri Das. Personal communication, September 1999.
16. National Kidney Foundation. (U.S.) Internet Home Page Information, Jan 1997.
17. Hari Sauri Das. A Transcendental Diary.
18. Tamal Krishna Goswami. TKG's Diary- Prabhupada's Final Days
19. American Diabetes Association. Internet Information Pages, 1997
20. Tamal Krishna Goswami. Personal communication, September 1999.
21. Srutakirti Das. Personal communication, September 1999.
22. Forshufvud S. Who Killed Napolean. 1961. London.
23. Abhirama Das. Personal communication, September 1999.

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